Reducing the burden of adverse events on the healthcare system

Up to 4% of emergency hospital admissions in the US are caused by adverse reactions to prescription drugs, claims a recent paper from the New England Journal of Medicine.

Are there practical steps that can be taken at the prescribing stage to reduce the impact of these AEs?

I’m sure we’ve all heard the claim that modern medicine and its reliance on “artificial” chemicals can often cause more harm than good. I’m also probably fairly safe in assuming that if you’re reading this post you don’t entirely agree.

In an attempt to answer this very question, three different approaches were tried with 33 Scottish primary care physicians –

Additional education on the specific hazards of simultaneously prescribing NSAIDs and antiplatelet medications (one of the largest causes of emergency admission for adverse drug reactions);

a computerized warning system that can inform doctors of hazardous prescribing practices;

and a monetary incentive to follow up with patients at risk.

The practices received these interventions at different times, and the prescribing behaviour of the doctors was monitored before, during and after the interventions. Unfortunately, the study did not specifically examine which of the interventions were the most effective.

The results showed a fall in hazardous prescribing from 3.7% to 2.2% of patients who had particularly high risk of exhibiting side-effects. Emergency admissions as a result of adverse reaction to the simultaneous NSAIDs and antiplatelet drugs use fell especially dramatically.

The study could not have hoped to eliminate hazardous prescribing. It is part of the doctors’ job to weight up the risks and benefits of a treatment package with a particular patient – avoiding all potentially hazardous drug combinations would inevitable put some patients at even greater risk.

However, it is interesting that the revised prescribing behaviour seemed to continue for at least 48 weeks after the financial incentive was removed, showing that the doctors perceived a genuine benefit to the behaviour.

All of this of course hinges on an effective system of pharmacovigilance – without which the dangers of drug combinations cannot be full appreciated.

Whitehall Training’s 4-module online training course covers all aspects of pharmacovigilance from the definition of adverse events to the regulatory framework in place throughout the world.